With antiretroviral therapy, over 1 million HIV-infected Americans are living longer, healthier lives. Consequently there is increased need to develop high quality, cost-effective HIV clinical care standards. Dr. Berry is an infectious diseases fellow and PhD student in clinical investigation at Johns Hopkins. His long term career goal is to make important contributions to understanding effective and economically sound HIV and other infectious diseases care strategies. His plans for development into an independent investigator include gaining competency in longitudinal data analysis, prospective studies of the effectiveness of clinical interventions, economic evaluation methods, and sexually transmitted infections subject knowledge to complement his HIV knowledge base. He will benefit from an outstanding mentoring team led by Drs. Kelly Gebo and Jonathan Zenilman. His proposed research is nested within his mentors'ongoing projects, and he will take advantage of classes and conferences available within the rich research environment of the Johns Hopkins Schools of Medicine and Public Health. Tens of thousands of asymptomatic gonorrhea (GC) and chlamydia (CT) cases may go undetected each year among HIV-infected Americans engaged in medical care. Detecting these infections has the potential to decrease HIV transmission and reduce adverse outcomes of GC and CT such as pelvic inflammatory disease. Despite these potential benefits and screening guidelines issued by the Centers for Disease Control and Prevention in 2003, GC/CT screening remains poorly implemented in HIV clinics across the nation. This proposal's central hypothesis is that universal annual GC/CT screening programs can be effective in clinical HIV practice and cost-effective for HIV-infected women and men <40 years old. The proposed research aims to: 1) Compare annual GC/CT testing and case detection rates before and after the 2003 guidelines using existing data from the HIV Research Network, a multicenter clinical cohort. 2) Determine if computer facilitated universal screening increases GC/CT case detection compared to the current standard of care using a pre/post intervention study. 3) Determine the cost-effectiveness of computerized universal screening versus current practice and a program of no screening. Up to 10% of persons living with HIV may have asymptomatic gonorrhea (GC) or chlamydia (CT) at any given time. Detecting these GC and CT cases helps reduce HIV transmission and decreases the long-term consequences of GC and CT such as pelvic inflammatory disease. This research will examine if computer facilitated universal annual screening may be an optimal means of detection among HIV-infected persons.